A spray-as-you-go airway topical anesthesia attenuates cardiovascular responses for double-lumen tube tracheal intubation

Background: The spray-as-you-go airway topical anesthesia and nerve block technique are commonly used in awake tracheal intubation. However, their effects have not been described for double-lumen tube intubation. A prospective randomized study was designed to compare their intubation effects in thoracic surgery patients. Methods: Sixty-six ASA physical status I and II patients were scheduled to undergo double-lumen tube(DLT) tracheal intubation for thoracic surgery. They were randomly assigned into control (Group C), ultrasound (Group U), and flexible intubation scope (Group F) groups with 22 cases in each group. Patients in Group C were induced with a standard anesthetic regimen. Patients in Group U and Group F were treated with superior laryngeal nerve(SLN) block combined with transtracheal injection and given a spray-as-you-go airway topical anesthesia respectively before intubation. Hemodynamic variables during intubation were recorded. Additional patient data were recorded including the occurrence of adverse events, the level of hoarseness, the occurrence of sore throat, memory function and the level of patient satisfaction with anesthesia. Results: The blood pressure and heart rate of patients in group C significantly increased 1 min after tracheal intubation (P<0.05) compared to before anesthesia yet the blood pressure and heart rate of patients in Groups U and F remained stable. During observation, there were 10 cases of hypertension in Group C, 6 cases in Group U and 1 case in Group F. In Group C, tachycardia was observed in 9 patients along with 9 cases in Group U and 4 cases in Group F. In Group U, 4 patients experienced puncture and bleeding were and 8 patients had a poor memory of transtracheal injection. No significant differences were found in the incidence of hoarseness, sore throat, and satisfaction with anesthesia in postoperative follow-up. Conclusions: Spray-as-you-go airway topical anesthesia and SLN block combined with transtracheal injection technique can inhibit the cardiovascular response during DLT tracheal intubation. The spray-as-you-go technique has fewer complications and more advantages compared to other approaches.